Acute Delirium

GENERAL INFORMATION:

What is acute delirium? Delirium is a condition where there is a change in how you think and feel, and your level of consciousness. Consciousness is the state of how awake, alert, and aware you are of things around you. The word acute is used to describe problems that start suddenly, worsen quickly, and last for a short time. With acute delirium, you have trouble remembering things, working with people, or doing things you usually do. You are at greater risk for delirium if you are in a hospital or other health care setting. Older adults and those who have medical conditions, or just had surgery are also at higher risk. Acute delirium may come and go. It can quickly change between better and worse. For some people, treatment can make delirium go away, but for others, it continues for months or years.

What causes acute delirium? Acute delirium may happen when areas and functions of your brain are damaged. One or more conditions can work together to cause delirium, or its cause may be unknown. The following may cause acute delirium, or increase your risk of having it:

• Drugs and alcohol: Drinking too much alcohol (found in beer, wine and other adult drinks), or using street drugs. If you have drunk alcohol or used drugs for awhile and suddenly stop, this can also cause delirium.
  
  
• Harmful substances: Breathing in or being around strong chemicals, or dangerous smoke and fumes.
  
  
• Hospitalization: Staying in the hospital after surgery, especially if you need to stay in the intensive care unit (ICU). Coping with medical problems while you are in the hospital also increases your risk of having delirium.
  
  
• Malnutrition: If you do not eat or drink enough, malnutrition can occur. This can also happen if you have a medical problem that stops your body from using or absorbing food.
  
  
• Medical conditions: Blood carries oxygen in the body to places that need it, such as your brain. Conditions that decrease or stop blood from reaching your brain can lead to delirium. This can include conditions such as cancer, dementia, depression, stroke, or Parkinson disease. Heart problems, such as a heart attack or heart failure can also lead to delirium. Lung problems, bleeding, kidney or liver failure, HIV infection, and having to stay in bed for a time can also cause delirium. If you cannot see or cannot hear well, this can also lead to delirium.
  
  
• Medicine: Certain medicines, such as anticholinergics and those containing dopamine, may put elderly people more at risk for having delirium.

How can I tell caregivers about my delirium? You or those around you should tell caregivers when the condition started and what symptoms you felt. Tell them when and how your symptoms improve or get worse. Tell them if you had an accident or head injury. Tell them about any numbness (loss of feeling) or weakness in your body. Tell them about any medical problems that you have. Tell them if you are around harmful chemicals at work or at your home. Tell them if you had any recent surgery or are taking any medicines. They need to know if you drink alcohol, and how much and how often you drink it. Tell them if you use street drugs, what kind and how much you use, and how long you have been doing this.

What signs and symptoms may be related to my acute delirium? You may have fast mood changes, such as feeling very happy one moment, and very sad the next. Your condition may come and go, or get better or worse at times. You may be unable to move correctly, feel shaky, and the pupils in your eyes may move very fast. Acute delirium can be divided into three main types. With these, you may have the following signs and symptoms:

• Hyperactive: With this type, you feel alert and active, and may have any of the following:
  
  
  • Confusion and forgetting who people are, where you are, or what time it is.
    
    
  • Easily angered, restless, or excited.
    
    
  • False beliefs about yourself and the area around you. These are called delusions.
    
    
  • Hearing, seeing, smelling, tasting, or touching things that are not really there. These are called hallucinations.
    
    
  • Losing focus or attention on what you are doing, or forgetting things that have just been said.
    
    
  • Problems talking and thinking about things.
  
  
• Hypoactive: With this type, you feel slow and less active, and may have any of the following:
  
  
  • Feeling very lazy or sleepy.
    
    
  • Not caring about what happens around you, and not wanting to eat.
    
    
  • Not getting enough sleep.
    
    
  • Not knowing who you are, where you are, or the date or time.
    
    
  • Slow to think, move, or respond to people.
  
  
• Mixed: With mixed delirium, you have some signs and symptoms of the other two types of delirium.

How may my acute delirium be treated? Poor blood flow to your brain, blood clots, and certain other conditions that cause acute delirium are very serious and can cause death. If a medical condition is causing your delirium, caregivers will treat it first. You may also need one or more of the following :

• Medicines:
  
  
  • Antipsychotics: These are used for conditions that affect your thinking and your feelings. They block a chemical in your brain called dopamine, and help you stop seeing or hearing things that are not there.
    
    
  • Benzodiazepines: These are used if your delirium occurs after you suddenly stop using drugs or drinking alcohol.
    
    
  • Vitamins: Vitamins such as vitamin D may be given to help your body get the nutrients that it needs.
  
  
• Treatments:
  
  
  • Counseling: Caregivers will work with you to help you feel calmer and able to talk. They will talk to you about your thoughts and feelings. They will help you remember where you are, and the date and time. They will work with you to keep you and those around you safe.
    
    
  • Education: Your caregiver will explain your condition to people who are close to you, such as your friends and family. He will talk to them about what to expect over time. He will tell them that you may do things that you usually would not do, such as becoming violent.
    
    
  • Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.

What can I do to prevent my acute delirium?

• Eat a healthy diet and drink enough liquids.
  
  
  • Eat a variety of healthy foods such as fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat and fish. Ask your caregiver if you need to be on a special diet.
    
    
  • Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, good liquids to drink are water, juices, and milk. Try to drink enough liquid each day, and not just when you feel thirsty.
  
  
• Change your surroundings. Keep the room that you are in quiet, and at a good temperature. Use eyeglasses or hearing aids if you have them. Keep objects that you know and like around you where they can be seen. Have a calendar and clock near to remind you of the date and time. Ask people that you know to stay with you, and keep pictures of your family and friends nearby. Doing these things will help you stay aware of yourself and the area around you. They may also help you feel safe and calm.
  
  
• Talk to others. Talk to those around you when you feel lonely or sad. Having delirium can make you confused and forgetful. Ask someone when you forget the time, place, or people around you. Talk to caregivers right away if you are thinking about hurting yourself or others.
  
  
• Avoid falls. Stay away from places where you at a higher risk of falling. Ask your caregiver for more information about ways to decrease your risk of falling.
  
  
• Stop taking alcohol or street drugs. Ask your caregiver to help you stop drinking alcohol or using street drugs.
  
  
• Follow your caregiver's directions to manage your other medical problems. Call your caregiver if your signs or symptoms get worse, or you have new signs or symptoms.

Will I need appointments with other caregivers? You may need to see a psychiatrist to make sure your symptoms are not caused by other mental health problems. You may need to see a neurologist to have your brain and its functions checked. You may need to see caregivers to help you stop a drug or alcohol problem. You will need to see caregivers if you have a medical condition that can cause acute delirium. After starting treatment, you may need more appointments with caregivers to see if your treatment is working. Schedule and go to all appointments.

What should I expect with time and treatment? If you get help as soon as you show signs of acute delirium, this can stop your delirium from getting worse. Your symptoms may decrease or go away over time. Delirium in young people often goes away quickly without lasting effects. Delirium may be a long-term condition for older people. If you have other medical problems, delirium may last longer. It also puts you at higher risk of getting conditions such as pneumonia and pressure sores. After your delirium is gone, you may need to keep seeing mental health caregivers.

When should I call my caregiver? Call your caregiver if:

• You have trouble remembering things.
  
  
• You have trouble sleeping.

When should I seek immediate help? Call 911 or get to the nearest emergency room if:

• You fall down or otherwise hurt yourself.
  
  
• You feel that your moods have changed, or that you want to harm yourself or others.
  
  
• You cannot eat or drink, and you feel weak or dizzy.
  
  
• You have sores on your back, hips, or heels after being in bed.
  
  
• You have pain and swelling in your leg that does not go away.
  
  
• You have a cough, fever, trouble breathing, and pain in your chest.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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